Journal of Musculoskeletal Trauma

Comparison of the Results between Plating and Intramedullary Nailing for Ipsilateral Fibular Fractures in Pilon Fractures: Yong Jin Cho, Jun Young Lee, Jae Hwan Lim, Je Hong Ryu, Jung Ho Lee; J Korean Fract Soc 2021;34(3):97-104. Published online July 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.3.97

Abstract PDF: Purpose
To compare the results between plating and intramedullary nailing for ipsilateral fibular fractures in pilon fractures.
Materials and Methods
Among 124 patients with pilon fractures from November 2008 to March 2019, 50 patients with a fibular fracture were studied retrospectively and divided into two groups: Group A using a plate and Group B using a Rush pin. The radiological tests confirmed the fracture pat-terns (Rüedi–Allgöwer classification, AO/OTA classification) and evaluated the degree of reduction of fibular and tibial fractures after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) was examined for a clinical evaluation, and the complications were checked.
Results
The two groups showed similar distributions in gender, age, injury mechanism, diabetes, smoking, mean follow-up period, Rüedi–Allgöwer classification, AO/OTA classification, and open fracture. The fibular fractures were classified as simple, wedge, multiple, and segmental, showing significant differences between the two groups (p=0.03). There was no difference in the Talocrural angle, Shenton line, and Dime sign. In the reduction of pilon fractures, the appropriate reduction was obtained in 22 cases (88.0%) for both groups. The AOFAS averaged 83.24 in Group A and 80.44 points in Group B, showing no significant difference in complications (nonunion, malunion, infection, and arthritis).
Conclusion
Regardless of how the fibular fracture was fixed, the reduction of pilon fractures in both groups showed good results. Both intramedullary nail and plate fixation could be a suitable fixation method for ipsilateral fibular fractures with a low risk of shortening in pilon fractures.

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Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures: Sang Woo Kim, Chae Chil Lee, Sang Hun Ko, Il Yeong Hwang, Min Seok Kim, Woo Young Jin; J Korean Fract Soc 2019;32(1):1-5. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.1

PURPOSE
This paper suggests the use of distraction dynamic external fixators (DDEF) for the treatment of proximal middle phalanx fractures.
MATERIALS AND METHODS
Seven patients, who were diagnosed with comminuted intra-articular fractures at the base of the middle phalanx from February 2014 to November 2016, were enrolled in this study (volar aspect 6 cases, dorsal aspect 1 case). They underwent a closed reduction under a C-arm image intensifier, and DDEF was applied with general anesthesia. Range of motion (ROM) exercise was encouraged after 3 to 5 days postoperatively, and DDEF was removed after 5 weeks. Subluxation, angulation and displacement were evaluated 6 weeks postoperatively.
RESULTS
The patients who were treated with DDEF showed a normal proximal interphalangeal joint ROM (100Â°), and there was no subluxation or displacement on the X-ray film 6 weeks postoperatively. In addition, there were no signs of infection, such as local heat, redness, and pus-like discharge.
CONCLUSION
DDEF helps maintain the reduction and reducing forces through the ligamentotaxis. The joint stiffness is reduced, which it makes early return to daily life easier.

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Treatment of Neglected Proximal Interphalangeal Fracture Dislocation Using a Traction Device: A Case Report
Yongun Cho, Jai Hyung Park, Se-Jin Park, Ingyu Lee, Eugene Kim
Journal of the Korean Fracture Society.2019; 32(4): 222. CrossRef

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The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures: Suenghwan Jo, Jun Young Lee, Boseon Kim, Kang Hyeon Ryu; J Korean Fract Soc 2017;30(2):75-82. Published online April 30, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.2.75

Abstract PDF: PURPOSE
We evaluated the usefulness of an additional, 2.7 mm mini-locking plate for tibial pilon fractures.
MATERIALS AND METHODS
We studied 21 patients (14 males and 7 females), who were treated with a 2.7 mm mini-locking plate via the anterolateral approach for tibial pilon fractures between September 2012 and April 2014. The mean age was 43.85 years, and the mean follow-up period was 16.6 months. The radiologic outcomes were graded by the Burwell and Charnley modified system and clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score.
RESULTS
The mean union period was 14.3 weeks. At the final follow-up, radiologic results showed 16 excellent results, 4 fair results, and 1 poor result. The average VAS was 3.4 points; the average AOFAS score was 81.8 points. During the follow-up period, there were three cases of posttraumatic osteoarthritis and one case of superficial skin infection.
CONCLUSION
Additional anterolateral, 2.7 mm mini-locking plate may be a good treatment method to manage tibial pilon fractures.

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The Results of Two Stage Surgical Treatment of Pilon Fractures: Hong Moon Sohn, Jun Young Lee, Sang Ho Ha, Sang Hong Lee, Gwang Chul Lee, Kwang Hyo Seo; J Korean Fract Soc 2012;25(3):177-184. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.177

Abstract PDF

PURPOSE
To report the good results of two-stage treatment in pilon fractures.
MATERIALS AND METHODS
A retrospective study of 23 patients among 30 patients with pilon fractures from March 2006 to November 2008, who underwent two-stage treatment of pilon fractures with a minimum of 24 months follow-up. The mean follow-up period was 28 months (24~41 months). In the first stage of the operation, open reduction of the articular surface and external fixation were performed after minimal incision. As the soft tissue healed, locking compression plate fixation was performed with the Minimally invasive plate osteosynthesis. Radiographic evaluation was graded by the criteria of Burwell and Charnley, and functional assessment of the ankle was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.
RESULTS
The fractures were united within 16 weeks (12~30 weeks). The radiologic results showed anatomical reduction in 18 cases and a mean AOFAS score of 81. The mean range of ankle motion was 44 degrees. There were four complications: 1 case of wound infection and 3 cases of ankle osteoarthritis.
CONCLUSION
Two-stage treatment of pilon fractures is a good treatment method because it is designed to obtain early anatomical reduction, definitive stable fixation, low rates of soft tissue complication, and good range of ankle motion.

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Current Concepts in Management of Pilon Fracture
Jun-Young Lee, Sang-Joon Lee
Journal of the Korean Fracture Society.2014; 27(2): 173. CrossRef

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Comminuted Pilon Fractures: Comparative Outcome Analysis according to Surgical Techniques: You Jin Kim, Hong Geun Jung, Joo Hong Lee, Woo Sup Byun, Sung Tae Lee; J Korean Fract Soc 2007;20(1):6-12. Published online January 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.1.6

Abstract PDF

PURPOSE
To evaluate the overall surgical outcome of the tibial pilon comminuted fractures and perform the comparative analysis between the limited internal fixation-external fixation group and the delayed open reduction-internal fixation (ORIF) group.
MATERIALS AND METHODS
From June 1997 to June 2004, 17 tibial pilon comminuted fractures were treated with the limited internal fixation-external fixation (6 cases) or the delayed open reduction-internal fixation (11 cases). The average age of the patients was 47.7 years (range: 41~63 years), male was fourteen patients, female was three. Follow-up period was average 33.6 months (range: 12~84 months). The clinical outcomes were evaluated by using AOFAS ankle-hindfoot score and patient satisfaction was also evaluated.
RESULTS
AOFAS score at final follow-up was 80.4 points, and 88% of the patients were satisfied with the results. AOFAS scores of the external fixation group and the delayed ORIF group were average 77.0 points and 82.2 points respectively, which did not show the statistical difference (p>0.05). Bony union was achieved at average 16.0 weeks. There were 18 complications such as skin necrosis.
CONCLUSION
We have achieved relatively encouraging functional results and high patient satisfaction for pilon comminuted fractures, without significant result difference between the two surgical techniques.

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The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures
Suenghwan Jo, Jun Young Lee, Boseon Kim, Kang Hyeon Ryu
Journal of the Korean Fracture Society.2017; 30(2): 75. CrossRef

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Arthroscopically Assisted Limited Open Reduction and Ilizarov External Fixation of Tibial Pilon Fractures: Jin Young Lee, Gab Lae Kim, Hyung Seok Oh, Kun Ho Shin, Deok Yong Park; J Korean Fract Soc 2006;19(2):176-181. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.176

Abstract: PURPOSE
To evaluate the clinical results of the pilon fractures treated with arthroscopically assisted limited open reduction and Ilizarov external fixation.
MATERIALS AND METHODS
This is a retrospective study of the clinical result, bone union, complication and postoperative ankle function of 22 pilon fractures treated with arthroscopically assisted limited open reduction and Ilizarov external fixation between January 1999 to March 2004.
RESULTS
Clinical follow up averaged 16 months, with an average age of 39.2. All patients with type 1 and 2 fracture had excellent or good score by Ovadia and Beals criteria. Closed fractures healed within 13 weeks and open fractures within 16 weeks after surgery in average. Average range of motion of the ankle was 12o dorsiflexion (0~20 degree) and 25o plantar flexion (15~35 degree).
CONCLUSION
Minimal soft tissue dissection and anatomical reduction are very important factor for minimizing complication and satisfactory ankle function. So, arthroscopically assisted limited open reduction and Ilizarov external fixation is an effective treatment option for tibial pilon fractures.

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Complications after treatment of tibial Non fracture: Ki Do Hong, Sung Sik Ha, Hyun Jong Cha; J Korean Soc Fract 2001;14(4):668-676. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.668

Abstract PDF: PURPOSE
Aim of this study was to find the treatment and preventive method of the complication occurred after treatment of tibial pilon fracture. MATERIAL AND METHODS: 10 cases of complication, which has required the unplanned operative treatment among 25 cases of tibial pilon fracture from 1994 to 1999 were analyzed rertrospectively according to the Ruedi-Allgower classification, open or closed fracture, isolated or polytrauma , type of complication, type of procedure, primary or delayed wound closure.
RESULTS
There were 1 type I, 3 type II, and 6 type III Ruedi-Allgower fracture type, 3 open fracture, 7 isolated and 3 polytrauma. 6 required plastic surgery procedure such as pedicle flap or full thickness skin graft and 7 required orthpaedic procedure such as osteotomy, cancellous bone graft, metal removal and currettage, debridement of ankle.
CONCLUSION
The complications after treatment of tibial pilon fracture are classified to intraoperative, early and late postoperative complication. Intraoperative complication include penetration of the joint by screw and inadequate reconstitution of the articular surface which can be avoided by taking intraoperative roetgenograms, early complication include wound necrosis which can be minimized by good soft tissue technique, late complication include nonunion, joint stiffness and posttraumatic arthritis can be treated by osteotomy, cancellous bone graft and anatomic reduction with early motion.

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Treatment of Articular Fracture of the Distal Tibia (Pilon Fracture) with Limited Open Reduction and External Fixator: Hui Taek Kim, Moon Bok Song; J Korean Soc Fract 2000;13(2):272-280. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.272

Abstract PDF: PURPOSE
: To evaluate the usefulness of the treatment method of limited open reduction for the articular surface and combined. external fixation in a tibial pilon fracture.
MATERIALS AND METHODS
: We reviewed 15 cases of pilon fracture treated by the combined internal and external fixation method. The fracture was classified by Ruedi and Allgower's classification: 3 cases of type I , 7 cases of type II and 5 cases of type III. The result was analyzed by Ovadia and Beals' radiologic, subjective and objective criteria of assessment.
RESULTS
: The results were 12 good and 3 fair in the radiologic evaluation; 1 excellent, 9 good, 3 fair and 2 poor in the objective evaluation; and 5 good, 8 fair, 2 poor in the subjective evaluation. The mean duration of the bony union was 6.5 months (5-11 months). The most common complication was the limitation of the ankle joint. Intra-articular arthroscopic adhesiolysis and extra-articular soft tissue release were helpful to increase the range of motion of the ankle joint.
CONCLUSION
: This technique provides a satisfactory result in the anatomical reduction of the articular fracture, in the management of the soft tissue problem particularly in open fracture, and permits early motion of the ankle joint in the pilon fracture.

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Operative Treatment of the Tibial Pilon Fractures: Suk Woong Yoon, Tae Sung Hwang, Byung Gue Park, Sang Deog Kim; J Korean Soc Fract 1999;12(3):622-631. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.622

Abstract PDF: Pilon fracture which is defined as a comminuted intraarticular fracture of distal tibia has been known to be difficult to manage because high axial compression and rotational forces to the ankle joint result in impaction, severe comminution, metaphyseal disruption, and soft tissue trauma. Several authors have reported good results using an AO group treatment principle. However, others have documented less favorable results such as skin slough, wound infection, and osteomyelitis. Recently, satisfactory results were obtained by the treatment with open reduction and fixation using Ilizarov method. We reviewed and analyzed 22 cases of the pilon fracture treated by the two methods O.R.I.F. and fixation by Ilizarov method) and compared the results to find out the usefulness of fixation by Ilizarov method, from Feb. 1993 to Mar. 1997 at the Department of Orthopedic Surgery, Seoul Red Cross Hospital. Fixation by Ilizarov method using ligamentotaxis and occasional minimal open reduction was effective for fracture reduction. It also decreased complications such as wound infection, skin necrosis, and osteomyelitis because it did not need extensive soft tissue dissection. And, it was also useful for severe comminuted fracture, open fracture, and fracture with extensive diaphyseal extension to proximal metaphysis.

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Minimal Surgical Treatment of the Tibial Pilon Fracture: Min Young Chung, Chang Woo Kim, Joon Kwon Jung, Eun Hwan Bae, Ho Keun Park, Seong Ho Park, Jang Won Hur; J Korean Soc Fract 1999;12(1):113-118. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.113

Abstract PDF: The goals of the treatment of pilon fracture include to restore a normal anatomy and functional level of uninjured state. We analysed the clinical outcomes of the treatment of pilon fractures with calcaneal traction and percutaneous intramedullary nailing in the fibula (group A, 12 cases), or open reduction and internal fixation (group B, 11 cases) in 23 cases between April 1994 and March 1997. All of the patients were followed for at least one year (average, 18 months; range, 12 to 24 months). Fifteen patients were male (group A, 8; group B, 7), and eight were female (group A, 4; group B, 4). Falling-down injury is the most common cause and automobile accident is the second. According to the R.. uedi and Allg.. ower classification, type II fractures were most common. In the group A, two of the 12 fractures were type I, six were type II, and four were type III, and in the group B, two of the 11 fractures were type I, six were type II, and four were type III. According to the criteria of Mast and Teipner, in the group A, six were good result and six were fair, and in the group B, four were good, five were fair, and two were poor. A nonunion with wound infection and a malunion developed in the group B. The results in the group A were better than those in the group B in clinically, we propose the minimal surgical treatment is useful treatment option of pilon fracture.

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Limited Internal Fixation for the Treatment of the Pilon Fracture: Phil Hyun Chung, Suk Kang, Sang Ho Mun, Won Suk Chae; J Korean Soc Fract 1998;11(4):841-848. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.841

Abstract PDF: The intraarticular fractures of the distal tibia-so called pilon fracture or plafond fracture- were caused by high energy and axial compression forces arising from motor vehicle accidents or falls from a height, and it is frequently associated with severe vomminution and soft tissue injury. Expecially soft tissue injury has been considered as a difficult problems to treat these fractures and there has been many controversies in the methods of treatment. We analized 30 cases of pilon fracture who were treated by limited internal fixation from March 1992 to March 1997. the average follow up period was 26 months(from 15 to 50 months). The results as follow: 1. According to Ruedi and Allgower classification, Type I were 4(13%), Type II were 14(46%) and Type III were 12(40%) cases. 2. By using Ovadia and Beals' radiologic assessment, limited internal fixation showed good and fair results in about 80% of cases. 3. By using Mast and Teipner's clinical functional assessment, limited internal fixation showed good and fair reults in about 80% of cases. 4. Complications after operation were traumatic arthritis(17%) and nonunion(3.3%). But there were no complications such as wound infection and skin necrosis. Limited internal fixation with casting provides good result to treat pilon fractures and it reduces the complications of soft tissues problem.

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Operative Results in AO Type C3 of Tibial Pilon Fracture: Limited Internal Fixation and Hybrid External Fixation: Byeong Yeon Seong, dong Seong Park, seung Jun Park, Sang Wook Kim, Taek Geon Lee; J Korean Soc Fract 1998;11(3):576-584. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.576

Abstract PDF: The intraarticular fractures of the distal tibia has been the most difficult problem due to severe comminution of itself, little bone mass and poor circulation of soft tissue. Recently limited internal fixation with hybrid external fixation has been reported to provide a good clinical results for the severely commnuted or open pilon fractures as a AO type C3. From February 1994 to February 1996, the authors analyzed the clincal and radiological results of 2 year follow-up in 7 cases of the AO type C3 pilon fractures who were treated with combination of limited internal fixation and hybrid externalfixation. 6 cases had good or excellent clinical and radiological results without any serious complications such as skin sloughs, skin infection, malunion and nonunion, but one case had a nonunion who were treated with internal fixation and autogenous iliac bone graft. We believe that the combination of limited internal fixation and hybrid external fixation that does not cross the ankle joint, provides the good clinical results in AO type C3 pilon fractures by early ankle joint motion.

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Operative Treatments of the Tibial Pilon Fractures: Duk Yong Lee, Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suck Ha Lee, Dong Ki Lee, Yong Chan Lim, Jae Joon Shin; J Korean Soc Fract 1998;11(2):390-397. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.390

Abstract PDF

Treatment of tibial pilon fractures is difficult to manage because of its comminuted pattern of the intra-articular fracture of the ankle, the articular incongruity, associated with soft tissue injury and its complication. The modern concept of fracture mordality are the open anatomical reduction, stable internal fixation with correct length of fibula and functional aftercare. We analyzed 17 cases which underwent open reduction and internal fixation for the tibial pilon fracture at the Korea Veterans Hospital from March 1990 to September 1996. 1. The most common type was type III according to Ruedi and Allgower's classification. 2. The treatment was open reduction and internal fixation in all cases and the results were above fair by Ovadia and Beals criteria in 16 cases. 3. The union of fracture was taken in all cases and the duration of union was average 14 weeks. 4. The most common complication was the limitation of ROM in the ankle joint.

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Towards the synthesis of amphidinolide B. An intramolecular Stille coupling approach
M.Belén Cid, Gerald Pattenden
Tetrahedron Letters.2000; 41(38): 7373. CrossRef

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Application & Use of an Ilizarov Technique for the Pilon Fracture: Jin Hong Ko, Beom Koo Lee, Do Hyun Moon, Sung We; J Korean Soc Fract 1997;10(4):879-885. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.879

Abstract PDF: A pilon fracture, which is defined as a comminuted intraarticular fracture of distal tibia, violates the articular region and the metaphysis with occasional extension into the diaphysis, and renders the bone difficult to restore to its anatomic shape. The best known treatment of the pilon fracture is, as recommended by A-O group. In the treatments of the fractures with severe comminution or with significant open soft tissue injury aggressive tries for internal fixation with plate and screws in the distal tibia will result in inevitable stripping of the soft tissue and the periosteum. Therefore, dangers of the delayed union, nonunion, soft tissue necrosis and infection will be increased. The authors treated 14 cases by the Ilizarov external fixation technique for treatment of pilon fracture of the tibia. The average duration of external fixation was thirteen weeks. The results were as follows. v1. Such techniques are especially useful in those injuries with extensive aricular communition and in the open pilon fracture with significant soft tissue compromise. 2. The average duration of external fixation was 13 weeks and the time to clinical union averaged 16.4 weeks. 3. In case of accurate reduction, the better clinical result was obtained.

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Surgical Treatment of the Pilon Fractures: Jung Jae Kim, Jong Hi Park, Woo Shin Cho, Key Yong Kim; J Korean Soc Fract 1997;10(3):492-500. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.492

Abstract PDF: The intraarticular fractures of the distal tibia. so-called pilon fractures have been difficult in management due to the severe comminution of articular surface and frequent soft tissue problems. So there have been many controversies in the method of treatment. Although historically the results of various type of treatment of these fractures have been less than optimal, there has been a recent trend that suggests success in the majority of cases through operative treatment following the principles outlined by the AO/ASIF group. Among the patients of pilon fracture admitted to our hospital from October 1989 to August 1995 who were treated by open reduction and internal fixation, 32 patients(34 cases) were included who could be follow up for more than 2 years. According to AO/ASIF classification, type B1 5 cases, type B2 7 cases, type B3 5 cases, type C1 3 cases, type C2 4 cases, type C3 10 cases. The authors analyaed the clinical and radiological results of tibial pilon fractures exclusively treated by internal fixation. The results as follow : 1. Among 34 cases, 12 cases(35.3%) were not associated with of fibula fracture. There was no stastical relationship between the severity of pilon fracture and the presence of flbula fracture. 2. Good results in fracture reduction was obtained at 26 cases(76.5%) and good functional reults was obtained at 26 cases(76.5%). 3. The most commom postoperative complication was infection combined with skin problem(6 cases), which were treated by antibiotics and flap surgery. 4. Anatomical reduction and stable internal fixation of articular surface, careful manipulation of soft tissues and early range of motion exercise yielded good results of surgical treatment of pilon fracture.

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Limited Internal Fixation of Pilon Fractures: Sung Ho Han, Bo Kyu Yang, Chi Hong Kim, Tae Won Ahn, Wu Jun Chu; J Korean Soc Fract 1997;10(3):485-491. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.485

Abstract PDF: Pilon fracture is relatively an uncommon fracture involving the distal tibial articular surface. As usually being combined with many complications, it is difficult to manage. Among many treatment options limited internal fixation of the tibia with long screws and multiple pins augmented with external fixation or casting provide adequate stabilization without soft tissue compromise. Fractures were defined as type II in 10 fractures and type III in 16 by Ruedi-Allgowers classification. 16 fractures, 6 type II and 10 type III, had limited internal fixation and cast application. 1 type III fracture had limited internal and external fixation. 9 fractures, 4 type II and 5 type III, were treated by rigid tibial plating during a period of 5 years(Mar. 1990- Fed. 1995). By Burwells and Charnleys radiological criteria and clinical grading system, limited internal fixation showed 67% satisfactory results in type II and 64% in type III fractures while rigid tibial plating showed 75% satisfactory results in type II and 60% in type III fractures. 4(44%) patients with rigid tibial plating, and 2(12%) patients with limited internal fixation had complications. Pilon fractures are high energy injuries with significant associated soft tissue damage. limited internal fixation offers good solution to this difficult fracture problem.

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A Operative Treatment of the Tibial Pilon Fractures : For minimize soft tissue injury: Jae Do Kang, Kwang Yul Kim, Hyung Chun Kim, Moon Sub Yim, Sang Hoon Ko; J Korean Soc Fract 1997;10(2):346-355. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.346

Abstract PDF: The tibial Pilon fracture is difficult to manage because high energy axial compression and rotational forces which make severe injuries to the ankle joint, which result in impaction, severe comminution, metaphyseal disruption and soft tissue trauma. Though there are variable methods of treatment including manipulation and cast, calcaneal traction and cast, external fixation, pin and plaster, limited open reduction and external fixation, open reduction and internal fixation and arthrodesis, most of authors reported better result after a surgical treatment than that of conservative treatment. While there is no doubt that the treatment of ankle joint injuries is much improved today, complications are still very common for many reasons. We have reviewed the 19 cases of the tibial plafond fractures on 18 patients which were treated at orthopedic department, Walles Memorial Baptist Hospital, from March 1991 to February 1995. The results were as follows . 1. There were so much combined injuries that physician must evaluate other injury such as spinal compression fracture. 2. The most frequent type of pilon fracture was type 3, the 2nd was type 5 by Ovadia and Beals classification. 3. Regardless of the treatment method, type 1 and 2 were excellent subjective result by Ovadia and Beals subjective evaluation classificatioin, but in case of type 3, 4 we could get a good and excellent result by anatomical open reduction and internal fixation. 4. We could reduce complications of the postoperative wound infection and skin necrosis by posteromedial and posterolateral approach after skeletal traction and manual reduction for more than one week.

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A Clinical Study of the Tibial Pilon Fractures: Chil Soo Kwon, Jong Kuk Ahn, Jin Hyok Kim, Yerl Bo Sung, Hyung Jin Chung; J Korean Soc Fract 1997;10(2):338-345. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.338

Abstract PDF: The pilon fracture result from axial compression and rotational forces causing variable degrees of metaphyseal disruption, articular damage, and malleolar displacement. It is managements are closed reduction and plaster immobilization, skeletal traction, fibular stabilization alone, limited open reduction and extemal fixation, primary arthrodesis, and even immediate amputation. Recently limited open reduction and external fixation has been proved to provide good clinical results for the severely comminuted or open pilon fractures. Authors reviewed 20 cases of the pilon fractures. Among them 10 cases were treated with limited open reduction and external fixation from October 1989 to January 1994. The results were as follows : 1. Age distribution was from 14 years to 77 years(mean ; 47 years). 2. Of the 20 cases, male were 14, and female were 6. 3. The cause of injury were tracffic accident in 10 cases, slip down in 6 and fall from a height in 4. 4. The most frequent type of fractures was type III(12 cases : 60%) according to Ruedi and Allgower classification. 5. Limited open reduction and external fixation(10 cases) has shown better results than classic open recduction and internal fixation for severely comminuted or open pilon fractures.

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Clinical Evaluation for the Tibial Pilon Fractures: Kyung Jin Song, Joo Won Jung, Joo Bong Lee, Myung Sik Park, Byung Yun Bwang; J Korean Soc Fract 1996;9(1):200-204. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.200

Abstract PDF

Treatment for the tibial Pilon fractures involving ankle joint must be the most challenging one in the long bone fractures following lots of complications. We analyzed fourteen patients those who underwent surgical treatment for distal tibia fracture extending through the tibial plafond into the ankle joint. Under the Ruedi and Allgower classification two were in type I, two were in type II and ten were in type III. The Mean follow-uP Period was four years ranging from two to seven years. The purpose of this paper is to evaluate the treatment results of tibia Pilon fractures and analyBe the causes of complications. In surgical treatment method, we tried early open reduction and rigid internal fixation as far aas possible in the closed pilon fracture. We assessed the function under the objective and sutjective criteria of Ovadia and Beals. Two out of two in type I, one out of two in type II and four out of ten in type III Pilon fractures obtained good functional outcome. There were 3 wound infections, 1 malunion with reflex sympathetic dystrophy and 2 traumatic osteoarthritis as a complication. Type I and type II Pilon fractures proved to be amenable to open reduction, restoration of anatomic position, and stable internal fixation with early joint exercise. Nonanatomic reduction, unstable fixation, infection, and secondary arthrosis were associated in type III Pilon fractures with poor functional outcome after surgical treatment.

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Comminuted Pilon Fractures: Comparative Outcome Analysis according to Surgical Techniques
You-Jin Kim, Hong-Geun Jung, Joo-Hong Lee, Woo-Sup Byun, Sung-Tae Lee
Journal of the Korean Fracture Society.2007; 20(1): 6. CrossRef

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External Fixation and Limited Internal Fixation in AO Type C Pilon Fracture: Report of Five Cases: Eun Woo Lee, Soo Yong Kang, Il Seok Kim; J Korean Soc Fract 1995;8(1):243-247. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.243

Abstract PDF: Techniaue of biologic fixation and external fifation are playing an crucial role in the management of the severe comminuted fracture with soft tissue injuries. To evaluate the treatment of severe pilon fracture by a conbination internal and external fixation, five high Pilon fractures with open or severs soft tissue injries were treated by a medial external fixator with an articulated ankle hinge(EBI) and limited internal flxation. Two AO C2 fractures and three AO C3 fractures were followed for a minimum of 1 year. All fractures united and had good functional results without any serious complication. We believe that external fixation and limited internal fixation using biologic principle is an excellent alternative method in high energy, complex fracture with diaphyseal comminution.

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A Clinical Study of the Tibia Pilon Fractures: Jung Yoon Lee, Sung Keun Sohn, Kyung Taek Kim, Kyu Yeol Lee, Dong Man Park; J Korean Soc Fract 1994;7(2):256-268. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.256

Abstract PDF: A pilon fracture, which is defined as a comminuted intraarticular fracture of distal involve the articular surface and metaphysis with occasional extension in the diaphysis. The management has been notoriously difficult due to the associated injury, intraarticular fracture, severe communition of distal tibia, joint incongruity and soft tissue trauma. Most authors has reported good results after a surgical treatment by a principle of AO group treatment. Rescently, Bone et all reports that ROM and outcomes of the severly comminuted or open fractures of the distal intraarticular tibia were very good in using the external fixator. The result of treatment of 22 cases were analysed at the Department of Orthopedic Surgery, Dong-A University hospital from Mar. 1990 to Feb. 1993. The results were as follows; 1. The incidence of pilon fracture is 8.3% of all ankle fracture treated during same period. 2. The most common cause of injury is fall down(63.3%). 3. The most frequent type is type 3 (54.6%).(by Rudei & Allgower) 4. The most common associated injury is compression fracture of spine and calcaneal fracture(4 cases). 5. There are eight cases open Pilon fracture(36.3%) 6. We had treated severe communited fracture and open fracture by using external fixator, we achived good ROM and outcomes. 7. The more accurate reduction, the better clinical result. 8. Complication of the Pilon fracutre were traumatic arthritis, non-union, malunion, wound int, etc.

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A Clinieal Study of the Tibial Pilon Fractures: Cheol Kwak, Sung Seok Soe, Hyun Duk Yoo, Young Chang Kim, Jang Seok Choi, Young Ku Lee; J Korean Soc Fract 1992;5(2):260-267. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.260

Abstract PDF: Intraarticular fractures of the distal tibia, the so-called pilon tibial fracture, usually resultfrom a torsional injury, a motor vehicle accident, or a fall from a height. The management of these fractures has been notoriously difficult due to the comminution of the distal tibia, articular incongruity, and asscociat ed soft-tissue trauma. The best results of treatment reported for this fracture, have followed early open reduction and rigid internal fixation to restore length, recon struction of the plafond, primary cancellous bone-grafting, butress plate on tibia, early motion and prolonged non weight-bearing. The purpose of this study was to examine the experience of the Pusan Paik Hospital between 1986 and 1991 as it relates to the treatment of 20 pilon fractures and to correlates the Clinical fesults with fracture type. They were followed post-operatively for an average of 22.3 months. The results were as follows 1. The most frequent type of the fraEture was type III according to Ruedl and Allgowe Classification. 2. Open reduction and internal fixation in cases type II & III has showed better resulis than those treated conservatively. 3. The fibula fracture fixed internally with a plate first often makes re construction of the distal tlbia easier. 4. The most often complication was the ankle joint pain.

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Operative treatment of the tibial pilon fractures following AO/ASIFprinciple: Key Yong Kim, Sung Il Bin, Won Hyeok Oh; J Korean Soc Fract 1992;5(1):129-137. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.129

Abstract PDF: No abstract available.

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A Clinical Study of tibial Pilon Fractures: Key Yong Kim, Duck Yun Cho, Jai Gon Seo, Sung Bum Yang, Kyu Jung Cho; J Korean Soc Fract 1989;2(2):211-218. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.211

Abstract PDF: The tibial pilon fracture is one of the most difficult fracuture to treat because of severe metaphyseal bone defect, comminution of the articular surface, disruption of ankle mortise and accompanying soft tissues injury resulting from axial compression and rotational forces. The recent concept of management of tibial pilon fracture is to open and provide anatomical reduction with stable internal fixation, early joint motion and considerably delayed weight bearing. We reviewed 16 cases of tibial pilon fracture experienced from June 1985 to December 1 988 and the result were as follows; Tibial pilon fracture comprises 8.7% of all ankle fractures(183 cases) during the period and prevalent in male. According to the classification by Ruedi and Allgoewer, 2 cases of typeI, 9 cases of type II and 5 cases of type III. 3 cses treated conservatively and 13 cases operatively. Better results were obtaiined in latter group, and in typeI and type II than III. The important factors influencing the clinical result were the type of fracture and accuracy of reduction including maintainace of fibular length.

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